Diet in Infancy and Childhood

Yeshewas Abaynew(BSc, MPH)

 Objectives
By the end of this lecture, students will be able to understand:
• The importance of nutrition in the first year of life
• To recognize the changing nutritional needs of developing
children, from infancy to adolescence.
• To understand that nutritional recommendations for
children vary by age.

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 Infancy (Birth to 1 year)
• This is a critical period because the rate of growth and
development is more rapid than at any time in the life
cycle.
• Birth weight doubles by the age of 4 to 6 months and
triples toward the end of the first year.
• High growth rate necessitates supporting the infant’s high
need for nutrients and calories.
• Although the total amount of calorie and nutrients
needed by an infant is much less than that needed by an
adult, the amount per kg of body weight for calories and
most nutrients is higher at birth than at any other time.

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 Infancy…
• Milk is the sole source of nutrition up until 4 to 6 months of
age. Milk could be in the form of breast milk, infant formula,
or a combination of both.
• Breast feeding is superior to formula feeding because it offers
unique nutritional and non-nutritional advantages to both
infant and mother.
• Iron-fortified infant milk is an appropriate substitute or
supplement to breast feeding. The level of many nutrients are
higher in formula than breast milk. Calcium (260 mg/L in
breast milk as opposed to 470 mg/L in formula) is one
example. This higher level is based on the rationale that some
nutrients are less well absorbed from formula.

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 Infancy…
• Solid foods (such as cereals, pureed fruits and vegetables) can be
introduced when the infant is developmentally and physiologically
ready by the age of 4 to 6 months.
• Developmental readiness is evident when an infant can lift the head,
sit with support, and turn the head to indicate that he had enough to
eat.
• Physiologic readiness occurs when an infant begin to produce
enzymes capable of digesting complex carbohydrates and proteins
other than milk protein.
• Some parents, based on unsupported belief, begin providing solid
foods for their infants before 4 months of age. A major objection to
this behavior is that it may interfere with establishing sound eating
habits and may contribute to overfeeding.

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Infancy…
Assessing the Adequacy of Intake in Infancy
• The best indicator for receiving sufficient nutrition is the
adequacy of growth.
• Breast-fed infants usually have a slower growth rate than bottle-
fed infants.
• Infants with impaired growth related to undernutrition or illness
experience “catch-up” growth, which usually is completed by 2
years of age. Undernutrition may or may not permanently affect
growth based on its timing, severity, nature and duration.
• To assess growth percentile for age, height and weight
measurements are plotted on the appropriate growth chart. A
deviation of more than 2 percentile channels warrants a more
in-depth assessment of growth and nutritional status.

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 Infancy…
• Weaning
– The term weaning means gradually introducing semisolid and
solid foods to the infant until s(h)e is accustomed to the
regular family diet.
– Breast feeding should not stop. The foods should be rich in
iron and vitamin D.
– Prolonged breast feeding without supplements will lead to
poor growth rate, wasting and iron deficiency anemia.
 Infancy…
• How to introduce weaning food
– Start by a small amount of 1-2 teaspoonful once daily then
increase gradually.
– The food should be smooth in texture
– Do not give two new foods together
– Do not offer new food if the baby is unwell
– Some infants refuse or spit out the food at the start. Don’t
worry, try again and again
– Gradually increase the frequency of meals
– Teach the mother about proper hygiene

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 Between Infancy and Childhood
• The period between age 1 and 2 is a transition between
infancy and childhood. There is dramatic decrease in growth
rate reflected in disinterest in food.
• By the end of the first year, the child should be drinking from a
cup and eating many of the same foods as the rest of the family
although in smaller amounts.
• Around the age of 15 months, food jags may develop reflecting
autonomy and independence.
• At 2 years of age, children can completely self-feed and can
seek food independently.
• Growth, Basal metabolic rate and endless activity require an
energy supply of 1300 kcal/day for ages 1 to 3.
• Hunger, rather than adult meal schedules, guide the child’s
perception of time to eat.

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 Children 4 to 6 years old
• Children can have their independent eating styles.
• They understand the time frame of meals and can save their
appetite for meals.
• Snacks form an integral part of the child’s nutrient intake
• Children can develop a sense of responsibility for healthy food
selection. They can understand that although all foods are fine,
some (like fruits, vegetables, and low fat foods) can be eaten
more often than others.
• Parents should educate children that each food contains a
different assortment of nutrients and offer substitute choices
that the child can finally select from.
• Energy requirements increase to 1800 kcal/ day

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 Children 7 to 12 years old
• Actual growth may slow down at this stage
• The body is preparing for the puberty growth spurt
• Puberty for girls may begin from around age 9 and on and, for
boys, puberty maybe reached in early teen years
• This prepuberty time maybe reflected by weight build up; an
increase in chubbiness is not alarming if moderate eating and
physical exercises are maintained
• Parents should not overreact to the child’s overeating; otherwise
they may plant the seeds of eating disorders
• To rule out overeating, children can be asked if they are truly
hungry for food or are they just tired or thirsty
• Energy requirements increase to 2000 to 2200 kcal/day

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 Vitamins and minerals
• With cooperation of healthy child a well planned diet provide most nutrients
except iron.
– RDA for iron during childhood (1-3 years) is 7 mg.
– RDA for iron during childhood (4-8 years) is 10 mg.
• As iron is low source of iron, so much consumption of milk contribute to low iron
intake. Milk should be limited to 3-4 cups which allows room for diet rich in iron
like lean meats, legumes, fish, poultry and cereals etc.
• A child diet may also be deficient in other micronutrients like zinc, vitamin D & E.
– Those children who are on low fat diets i.e. low fat dairy products suffer more.
• Outside influences such as TV viewing, affect children preferences for low
nutrient density foods.
 Nutritional concerns of childhood

– Hunger
– Malnutrition, Micronutrients and PEM.
– Deficiencies of vitamins A, D, Zinc, Iron and proteins.
• These result in illnesses, stunted growth, limited development
and in case of vitamin A deficiency possibly permanent
blindness.

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 Disorder Unique to or Beginning in Infancy
and childhood
• Failure to thrive: It is inadequate gain in weight and/ or height
in comparison with growth and development standards. This
condition can be caused by disorders of the CNS, endocrine
system, congenital defects, or intestinal obstruction, or it can
occur due to inability to suck, chew, or swallow related to
neuromuscular problems.
• Nursing interventions and considerations for a child with
failure to thrive shall take into account that the cause or causes
of this condition must first be identified. Nutrition therapy
depends on the infant’s age and stage of development. Usually a
high-calorie, high-protein diet is indicated.

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 Food Guide Pyramid
The Food Pyramid, developed by the US Department of
Agriculture (USDA), is an excellent tool to help you make
healthy food choices. The food pyramid can help you choose
from a variety of foods so you get the nutrients you need, and
the suggested serving sizes can help you control the amount of
calories, fat, saturated fat, cholesterol, sugar or sodium in your
diet.
– Grains, Bread, Cereal and Pasta form the Base
– Fruits and Vegetables
– Lean Meat and Fish, Beans, Eggs
– Dairy Products
– Fats and Sweets